“I’m going crazy. I don’t understand myself at all. What I did yesterday was absolutely horrible: I ate everything in the refrigerator, a whole grape pie, a quart of ice cream, half a box of chocolate cookies, that’s all that was left, and a quart of milk. I ate as if this was to be the last time in my life. It was like a nightmare, but when I woke up after my attack, I realized that I had not been dreaming, all the containers were there, empty. When I start eating, I can’t stop, I can’t help it. Do you think I can really get through this, doctor?”
This is a 35 year old woman in front of me and her testimony may sound like thousands of others. I will call her Françoise. She is the mother of two children, a 7 year old boy and a 5 year old girl. She is a nurse by profession and is in charge of the intensive care unit in a hospital. She consulted me for her weight problem, she has about 10 kilos (22 pounds) in excess that she can’t manage to lose despite several efforts in this direction for 4 years.
In order to know Françoise better, I ask her to take the Mental Weight questionnaire. It is about fifty questions of a psychological nature. Answering the questionnaire takes about 25 minutes. It is in fact a behavioral monitor or, if you will, a scale that weighs what is going on inside our head gives a number that is like a behavioral weight. The ideal result is the same as the person’s ideal weight. The higher the result, the more the behavior is deficient and needs to be improved. The person can therefore evaluate once a month where he/she is in his/her behavior. In addition, it provides the physician with a personality profile that takes into account habits, motivation, stress and emotions.
Françoise’s results were very interesting: her behavioral weight was 170, which is very close to normal. Her profile showed a very well-balanced personality with great self-confidence. Her motivation was excellent. Her habits were quite good except for a few occasions of bulimia (hunger attacks with excessive food intake). The Mental Weight Questionnaire finally revealed the cause of these episodes: emotions. Her score on this questionnaire was 50, which is very high, since the normal score should not exceed 30. Two criteria were responsible for this state of affairs: a strong perfectionism and guilt.
As I tell Françoise her results, I see her relax and smile. “It’s true that I have confidence in myself and I believe that it is because of this that I succeed very well in everything I do, except unfortunately in my weight problem, I really don’t understand it. It frustrates me and I blame myself a lot.”
“To understand what’s going on, we’re going to have to study your behavior, the thoughts and emotions that precede your outbursts.”
She interrupts me:
“I’d rather not think about it and look to the future. It makes me feel funny, I feel bad when I think about it or talk about it. No, I’d rather not talk about my seizures anymore if you don’t mind, doctor.”
“I understand well, Francoise, your reaction. You feel guilty about what you did, it hurts you a lot because you have dedicated your life to excellence and you don’t accept that you are unable to control your binge eating. However, the only effective way to get rid of these attacks is to study your behavior. You will learn from your past failures to improve. This is the only way you can learn to improve your behavior and control your emotions, because it is the very study of your mistakes that will allow you to not make them again and ultimately to progress.”
“Anyway, doctor, I don’t even know why I did this. I can’t think of any good reason for my horrible behavior yesterday. Everything was fine as usual, my job, my children, my husband… I really don’t understand myself at all!”
It is not easy for Françoise to go back, because her bulimic crisis is in her memory like a wound that she especially does not want to reopen.
Binge eating is usually linked to emotional states. When we analyze the results of the Mental Weight questionnaire, we discover that Françoise is particularly vulnerable on this side.
“In the days leading up to your binge, did you experience any annoyances or frustrations?”
“No, I don’t see.”
“At home, haven’t the children or your husband been sick, upset?”
“No, they’re doing just fine. I couldn’t ask for more.”
“Is your health good?”
“Other than my weight problem, I feel great. I jog and exercise twice a week. Plus I play racquetball once a week. I need these physical activities to be in shape and to be able to do everything well that I have to do. My appearance for me is very important and I can’t accept my extra 20 pounds.”
“At work, how are you doing?”
“For the past month, I have been the nurse in charge of the intensive care unit. It was a shock to me, I didn’t think I would get the job because of my weight. I really enjoy my job, but it’s pretty stressful. It’s a lot of responsibility.”
In fact, Françoise’s job was very demanding. She had 12 nurses under her command and was responsible for the smooth running of the intensive care unit. Recently, there had been a union dispute between the support staff and management at the hospital. The union’s pressure tactics were leading to a deterioration in patient care. Everyone was suffering, the patients, the nurses, the attending physicians and, in turn, the person in charge of the unit, Françoise. Faced with a situation that she could not control and that was out of her hands, she tried to make up for the lack of care as best she could. In the end, the patients did not suffer too much. But it was with a great sense of frustration that she returned home after her day’s work.
“I find it appalling that, for union squabbles, patients are being deprived of the care they are entitled to. It is totally unacceptable. My parents instilled in me important moral principles, including a sense of responsibility and a job well done. I have to tell you that it can be frustrating to work in the workforce today.”
The day before her binge, Françoise had a spat with a union representative over the definition of essential patient care in the event of a support staff strike. That was the last straw. Françoise is a perfectionist who refuses to take half measures. As the union was forcing her to act against her principles, she had built up a lot of frustration. Finally, it was only the next day, without really realizing the cause and effect relationship, that her frustration automatically led her to throw herself on the food without any control.
When psychologists study a person’s behavior, here is how they break down the different phases:
1-an EXTERNAL FACT occurs
2-which may cause an EMOTION
3-which in turn provokes a BEHAVIOR
In the case of Françoise, what happened can be summarized as follows:
1-THE EXTERNAL FACT: she is forced by the union to do something contrary to her principles
2-THE EMOTION: she feels a great deal of frustration
3-The BEHAVIOR: she has a bulimic crisis.
The first thing that Frances must now understand is that her eating behavior following her frustration is completely automatic. That is to say that neither her will nor her conscious mind participated in it. It is a conditioned reflex that she has probably acquired since her early childhood.
“Indeed, I remember: when I was little, whenever I felt frustrated or disappointed, my mother would console me with candy. I think you are right. I don’t even have time to think about it and I end up in the refrigerator.”
It’s important to know that the bulimia that follows frustration is as automatic as pulling your hand away when it passes too close to a flame. This reflex you probably learned as a child, after burning yourself a few times.
“I understand better now why I have my binges, but can I break this habit, this automatic reflex to eat out of frustration? That doesn’t sound very easy to me!”
“It is indeed not very easy to break this habit. Emotions in particular, when they are intense, trigger behaviors of the same intensity almost spontaneously, so that the will does not have time to intervene. When you can anticipate an emotion or when the emotion you are feeling is of a lower intensity, it becomes possible to break the habit by changing the behavior. For example, instead of eating, you can go for a walk, write down your frustration, or quickly move on to another activity.”
“Are there other things to do when the emotion is strong and sudden? That’s more like it for me. Even though things are going well, with all the responsibilities I have to deal with at home and at work, you make me realize that I get frustrated more often than I thought.”
As a first step, I wanted Françoise to understand her behavior so that she could eliminate the guilt she was feeling toward herself as a result of her binge eating. This is very important: Françoise cannot be guilty. She is in fact the victim of a reflex, of a habit. One cannot be both victim and guilty. It is essential that she eliminates her feeling of guilt in order to progress normally towards the control of her emotions. Guilt is a negative emotion that can only lead to negative self-deprecating or self-punishing behavior.
Excerpt from the book Be Thin Master your emotions by Dr. Maurice Larocque.